Department of Otolaryngology, Walter Reed National Military Medical Center, Bethesda, Maryland 20889, USA.
Otolaryngol Head Neck Surg. 2012 Sep;147(3):583-7. doi: 10.1177/0194599812450256. Epub 2012 Jun 11.
Obstructive sleep apnea syndrome (OSAS) is a pervasive problem that affects millions worldwide. It is strongly linked to hypertension, coronary artery disease, and stroke. However, its association with mortality is not clearly quantified. A large database of patients who underwent sleep testing was explored for associations with all-cause mortality.
Database study.
Community-based use of a portable sleep study device.
More than 77,000 patients who underwent a validated, portable sleep study were matched to the Social Security Death File to establish mortality. Measures of OSAS severity and other confounding factors were correlated to all-cause mortality using survival analysis with multivariate Cox proportional hazards regression.
As expected, increasing age (adjusted hazard ratio [HR], 1.080; 95% confidence interval [CI], 1.074-1.086; P < .0001), body mass index (HR, 1.042; 95% CI, 1.033-1.051; P < .0001), and male sex (HR, 1.378; 95% CI, 1.190-1.595; P < .001) were associated with increased all-cause mortality. Epworth sleepiness score was also associated with mortality (HR, 1.015; 95% CI, 1.005-1.025; P = .002). Apnea-hypopnea index (AHI) was not associated with mortality after adjustment for age (HR, 1.001; 95% CI, 0.998-1.004; P = .416). However, within 10-year age subgroups, desaturation index (ages 41-50 years; adjusted HR, 1.217; 95% CI, 1.014-1.461; P = .035), apnea index (ages 21-30 years; HR, 1.632; 95% CI, 1.053-2.532; P = .028), and AHI (ages 31-40 years; HR, 1.222; 95% CI, 1.010-1.478; P = .039) were significantly associated with all-cause mortality in younger patients. In patients older than 50 years, age, sex, and body mass index were dominantly associated with mortality.
Increasing OSAS severity, measured by a validated home sleep test and quantified by AHI, the apnea index, and the desaturation index, is independently associated with modestly increased all-cause mortality in patients younger than 50 years after adjustment for major confounding factors.
阻塞性睡眠呼吸暂停综合征（OSAS）是一种普遍存在的问题，影响着全球数百万人。它与高血压、冠状动脉疾病和中风密切相关。然而，其与死亡率的关联尚未明确量化。本研究通过对一个接受睡眠测试的患者大数据库进行探索，以确定其与全因死亡率的相关性。
数据库研究。
社区使用便携式睡眠研究设备。
超过 77000 名接受了经过验证的便携式睡眠研究的患者与社会安全死亡档案进行匹配，以确定死亡率。使用多变量 Cox 比例风险回归进行生存分析，将 OSAS 严重程度和其他混杂因素与全因死亡率相关联。
正如预期的那样，年龄的增加（调整后的危险比[HR]，1.080；95%置信区间[CI]，1.074-1.086；P<.0001）、体重指数（HR，1.042；95%CI，1.033-1.051；P<.0001）和男性性别（HR，1.378；95%CI，1.190-1.595；P<.001）与全因死亡率的增加相关。嗜睡评分也与死亡率相关（HR，1.015；95%CI，1.005-1.025；P=.002）。在调整年龄后，呼吸暂停低通气指数（AHI）与死亡率无关（HR，1.001；95%CI，0.998-1.004；P=.416）。然而，在 10 年年龄亚组中，年龄在 41-50 岁的患者的低氧指数（调整后的 HR，1.217；95%CI，1.014-1.461；P=.035）、呼吸暂停指数（年龄在 21-30 岁的患者；HR，1.632；95%CI，1.053-2.532；P=.028）和 AHI（年龄在 31-40 岁的患者；HR，1.222；95%CI，1.010-1.478；P=.039）与全因死亡率显著相关。在年龄大于 50 岁的患者中，年龄、性别和体重指数是与死亡率相关的主要因素。
经过验证的家庭睡眠测试测量的 OSAS 严重程度增加，通过 AHI、呼吸暂停指数和低氧指数来量化，与年龄小于 50 岁的患者全因死亡率适度增加独立相关，在调整了主要混杂因素后。
